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Background: In the photodynamic therapy (PDT) of non‐aggressive basal cell carcinomas (BCCs), 5‐aminolevulinic acid nanoemulsion (BF‐200ALA) has shown non‐inferior efficacy when compared with methyl aminolevulinate (MAL), a widely used photosensitizer. Hexyl aminolevulinate (HAL) is an interesting alternative photosensitizer. To our knowledge, this is the first study using HAL‐PDT in the treatment of BCCs. Objectives: To compare the histological clearance, tolerability (pain and post‐treatment reaction) and cosmetic outcome of MAL, BF‐200 ALA and low‐concentration HAL in the PDT of non‐aggressive BCCs. Methods: Ninety‐eight histologically verified non‐aggressive BCCs met the inclusion criteria, and 54 patients with 95 lesions completed the study. The lesions were randomized to receive LED‐PDT in two repeated treatments with MAL, BF‐200 ALA or HAL. Efficacy was assessed both clinically and confirmed histologically at three months by blinded observers. Furthermore, cosmetic outcome, pain, post‐treatment reactions fluorescence and photobleaching were evaluated. Results: According to intention‐to‐treat analyses, the histologically confirmed lesion clearance was 93.8% (95% confidence interval [CI] = 79.9–98.3) for MAL, 90.9% (95% CI = 76.4–96.9) for BF‐200 ALA and 87.9% (95% CI = 72.7–95.2) for HAL, with no differences between the arms (P = 0.84). There were no differences between the arms as regards pain, post‐treatment reactions or cosmetic outcome. Conclusions: Photodynamic therapy with low‐concentration HAL and BF‐200 ALA has a similar efficacy, tolerability and cosmetic outcome compared to MAL. HAL is an interesting new option in dermatological PDT, since good efficacy is achieved with a low concentration. [ABSTRACT FROM AUTHOR]

Background: Lentigo maligna (LM) is an in situ form of melanoma carrying a risk of progression to invasive lentigo maligna melanoma (LMM). LM poses a clinical challenge, with subclinical extension and high recurrence rates after incomplete surgery. Alternative treatment methods have been investigated with varying results. Photodynamic therapy (PDT) with methylaminolaevulinate (MAL) has already proved promising in this respect. Objectives: To investigate the efficacy of ablative fractional laser (AFL)‐assisted PDT with 5‐aminolaevulinic acid nanoemulsion (BF‐200 ALA) for treating LM. Methods: In this non‐sponsored prospective pilot study, ten histologically verified LMs were treated with AFL‐assisted PDT three times at 2‐week intervals using a light dose of 90 J/cm2 per treatment session. Local anaesthesia with ropivacaine was used. Four weeks after the last PDT treatment the lesions were treated surgically with a wide excision and sent for histopathological examination. The primary outcome was complete histopathological clearance of the LM from the surgical specimen. Patient‐reported pain during illumination and the severity of the skin reaction after the PDT treatments were monitored as secondary outcomes. Results: The complete histopathological clearance rate was 7 out of 10 LMs (70%). The pain during illumination was tolerable, with the mean pain scores for the PDT sessions on a visual assessment scale ranging from 2.9 to 3.8. Some severe skin reactions occurred during the treatment period, however. Conclusions: Ablative fractional laser‐assisted PDT showed moderate efficacy in terms of histological clearance. It could constitute an alternative treatment for LM but due to the side effects it should only be considered in inoperable cases. Linked Commentary: L. Marini et al. J Eur Acad Dermatol Venereol 2020; 34: 440–441. https://doi.org/10.1111/jdv.16262 [ABSTRACT FROM AUTHOR]

Summary: Background: Daylight photodynamic therapy (DL‐PDT) with methyl‐5‐aminolaevulinate (MAL) is an effective treatment for mild and moderate actinic keratosis (AK). Objectives: To assess the clinical efficacy, tolerability and cost‐effectiveness of 5‐aminolaevulinic acid nanoemulsion (BF‐200 ALA) compared with MAL in DL‐PDT for grade I–II AKs. Methods: This nonsponsored, prospective randomized double‐blind multicentre trial included 69 patients with 767 grade I–II AKs located symmetrically on the face or scalp. A single DL‐PDT was given in a randomized split‐face design. The primary outcome was clearance of the AKs at 12 months as assessed by a blinded observer. The secondary outcomes were pain, treatment reactions, cosmetic outcome and the cost‐effectiveness of the therapy. Results: In the per‐patient (half‐face) analysis, clearance was better for the BF‐200 ALA sides than for those treated with MAL (P = 0·008). In total, BF‐200 ALA cleared 299/375 AKs (79·7%) and MAL 288/392 (73·5%) (P = 0·041). The treatment was practically painless with both photosensitizers, the mean pain visual analogue scale being 1·51 for BF‐200 ALA and 1·35 for MAL (P = 0·061). Twenty‐six patients had a stronger skin reaction on the BF‐200 ALA side, seven on the MAL side and 23 displayed no difference (P = 0·001). The cosmetic outcome was excellent or good in > 90% of cases with both photosensitizers (P = 1·000). The cost‐effectiveness plane showed that the costs of DL‐PDT were similar for both photosensitizers, but the effectiveness was slightly higher for BF‐200 ALA. Conclusions: Our results indicate that BF‐200 ALA is more effective than MAL in DL‐PDT for grade I–II AKs. BF‐200 ALA provides slightly better value for money than MAL. What's already known about this topic? Daylight photodynamic therapy (DL‐PDT) with methylaminolaevulinate (MAL) is effective and practically painless for mild or moderate actinic keratosis (AK). Its long‐term efficacy or cost‐effectiveness is rarely reported. What does this study add? A single treatment with 5‐aminolaevulinic acid nanoemulsion (BF‐200 ALA) was shown in a 12‐month follow‐up to be more effective than MAL for use in DL‐PDT given in a split‐face design for grade I‐II AKs. BF‐200 ALA provides slightly better value for money than MAL. Linked Comment: Dawe. Br J Dermatol 2019; 181:246–247. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

Background: Basal cell carcinoma (BCC) is the most common skin cancer in the Caucasian population. Eighty per cent of BCCs are located on the head and neck area. Clinically ill‐defined BCCs often represent histologically aggressive subtypes, and they can have subtle subclinical extensions leading to recurrence and the need for re‐excisions. Objectives: The aim of this pilot study was to test the feasibility of a hyperspectral imaging system (HIS) in vivo in delineating the preoperatively lateral margins of ill‐defined BCCs on the head and neck area. Methods: Ill‐defined BCCs were assessed clinically with a dermatoscope, photographed and imaged with HIS. This was followed by surgical procedures where the BCCs were excised at the clinical border and the marginal strip separately. HIS, with a 12‐cm2 field of view and fast data processing, records a hyperspectral graph for every pixel in the imaged area, thus creating a data cube. With automated computational modelling, the spectral data are converted into localization maps showing the tumour borders. Interpretation of these maps was compared to the histologically verified tumour borders. Results: Sixteen BCCs were included. Of these cases, 10 of 16 were the aggressive subtype of BCC and 6 of 16 were nodular, superficial or a mixed type. HIS delineated the lesions more accurately in 12 of 16 of the BCCs compared to the clinical evaluation (4 of 16 wider and 8 of 16 smaller by HIS). In 2 of 16 cases, the HIS‐delineated lesion was wider without histopathological confirmation. In 2 of 16 cases, HIS did not detect the histopathologically confirmed subclinical extension. Conclusions: HIS has the potential to be an easy and fast aid in the preoperative delineation of ill‐defined BCCs, but further adjustment and larger studies are warranted for an optimal outcome. [ABSTRACT FROM AUTHOR]

The effect of heliotherapy on psoriasis skin lesions and arthritis was studied in a trial comprising 4 weeks of therapy in the Canary Islands and a 6-month follow-up period. A total of 373 patients participated in the heliotherapy and 361 patients completed the follow-up period. The severity of skin lesions was evaluated using a psoriasis severity index (PSI), and that of the arthropathy by using an arthritis index (AI). During heliotherapy, the PSI decreased significantly from the initial median value of 4.5 to the final value of 0.2, A reduction in the PSI of at least 75% was achieved in 84% of the patients. Guttate psoriasis improved significantly better than plaque-type or erythrodermic psoriasis. There was no correlation between skin type and improvement. Initially, 129 patients had symptoms of arthritis. During heliotherapy, the AI decreased significantly from the initial median value of 6 to the final value of 2. The median time until starting another treatment after heliotherapy was 80 days, and the PSI had returned to its original value in 49% of the patients in 6 months. In patients with joint symptoms the AI returned to the pretreatment level within 6 months. A 4-week heliotherapy period effectively cleared psoriasis, alleviated joint symptoms, and reduced both morbidity and treatment requirement to a considerable extent in the ensuing 6-month period. [ABSTRACT FROM AUTHOR]

Summary: Actinic keratoses (AK) are areas of sun‐damaged skin found mainly on parts of the body which have received lots of sun exposure. At first, they can be hard to see, and are more easily felt, being rough, like sandpaper. They may grow to a centimetre or two in diameter. Up to 20% of AKs may progress to a type of skin cancer called squamous cell carcinoma (SCC) within 10 to 25 years. One treatment option is a type of photodynamic therapy called Daylight photodynamic therapy (DL‐PDT) in which a cream, containing a 'photosensitiser', is applied to the lesion (affected area of skin). This photosensitiser is, by itself, inactive. However, when light of a certain wavelength shines onto skin to which the photosensitiser has been applied, the photosensitiser is activated and the treatment kills the abnormal cells in the skin. This study aimed to compare the efficacy (how well it works), tolerability (including pain and side effects) and cost‐effectiveness of two types of photosensitizer, called BF‐200 ALA and MAL. Altogether 69 patients with a total of 767 AKs located symmetrically on the face or scalp were treated at three centres in Finland. A single session of DL‐PDT was given in a randomized split‐face design, i.e. one half of the face was treated with one photosensitizer and the other half of the face with the other. The results were assessed at 12 months after treatment by a blinded observer, meaning they did not know which treatment was used on each side. The authors found out that BF‐200 ALA cleared significantly more AKs than MAL (79.7% vs. 73.5%). When comparing the half‐faces per single patient, the clearance of AKs was significantly better for the BF‐200 ALA treated sides than for those treated with MAL. The patient‐reported pain during the light treatment was low for both photosensitizers with no significant difference between them. The treatment‐related skin reactions a week after DL‐PDT were stronger on the sides treated with BF‐200 ALA. The cosmetic outcome (meaning how it looked) at 12 months was excellent or good in >90% of cases with both photosensitizers. The costs of DL‐PDT were similar for both photosensitizers, but the effectiveness was slightly higher for BF‐200 ALA. The authors conclude that BF‐200 ALA is more effective and provides slightly better value for money than MAL in DL‐PDT for mild and moderate AKs. Linked Article: Räsänen et al. Br J Dermatol 2019; 181:265–274 [ABSTRACT FROM AUTHOR]

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